The study evaluated the effect of ultrasound-guided perfusion index (PI) adjustment on hemostasis at the femoral artery puncture site in patients undergoing vascular interventions. A total of 98 patients from Ganzhou People's Hospital were randomized into the experimental group (n=50) and the control group (n=48) from July to September 2025. The trial group received ultrasound-guided compression to identify the optimal injection site and establish the target PI from the big toe, followed by a pressure bandage to maintain the PI at or below this target. The control group had conventional compression based on clinical experience and dorsalis pedis pulse. The success of hemostasis after removing the bandage, the pain score on the VAS scale and the PI values were measured. Hemostasis success was significantly improved in the trial group (16% versus 41.7% in the control group; difference 25.4%; 95% CI 0.05%; RR 0.187 to 0.787; p=0.005). Treatment of PI under ultrasound significantly improved hemostasis compared to empirical methods. The study is registered under ChiCTR2500105617 at ChiCTR.org.cn.